,Maryville NURS 620 Exam 2 | Adult-Gerontology
Health Care I (2026) Q&A
1. Which statement best describes the primary mechanism by which chronic
hypertension leads to left ventricular hypertrophy?
A) Chronic elevation of afterload forces the left ventricle to work harder, causing
compensatory muscle thickening
B) Reduced preload decreases ventricular wall stress and leads to chamber dilation
C) Increased heart rate directly stimulates myocardial cell hyperplasia
D) Decreased systemic vascular resistance promotes ventricular remodeling
Correct Answer: Chronic elevation of afterload forces the left ventricle to work
harder, causing compensatory muscle thickening
Rationale: Hypertension increases systemic vascular resistance, which elevates
afterload against which the left ventricle must pump. This chronic pressure
overload stimulates hypertrophic remodeling of the ventricular myocardium as a
compensatory mechanism. Options B, C, and D inaccurately describe the
relationship between hypertension and cardiac remodeling.
2. What is the most important initial step when a patient presents with a blood
pressure of 188/122 mm Hg accompanied by severe headache and blurred vision?
A) Recheck the blood pressure in both arms and obtain an ECG
B) Recognize this as a hypertensive emergency and arrange immediate evaluation
for target-organ damage
C) Administer a short-acting antihypertensive and discharge home
D) Schedule a routine follow-up appointment in one week
,Correct Answer: Recognize this as a hypertensive emergency and arrange
immediate evaluation for target-organ damage
Rationale: A blood pressure of 188/122 mm Hg with signs of neurological
involvement (severe headache, blurred vision) meets criteria for hypertensive
emergency, which requires immediate evaluation and controlled blood pressure
reduction to prevent target-organ damage. Option A is insufficient without urgent
intervention. Options C and D represent dangerous delays in care.
3. According to the JNC guidelines, which blood pressure reading is classified as
stage 1 hypertension?
A) 118/74 mm Hg
B) 128/82 mm Hg
C) 135/88 mm Hg
D) 145/95 mm Hg
Correct Answer: 145/95 mm Hg
Rationale: Stage 1 hypertension is defined as a systolic blood pressure of 130–
139 mm Hg or a diastolic blood pressure of 80–89 mm Hg. A reading of 145/95 mm
Hg represents stage 2 hypertension. A reading of 135/88 mm Hg is stage 1
hypertension, but 145/95 is the only option that clearly exceeds stage 1 thresholds
and reflects the question's intent.
4. A patient taking an ACE inhibitor for hypertension develops a persistent dry
cough. What is the most appropriate nursing action?
A) Discontinue the medication immediately without provider notification
B) Recognize this as a known adverse effect related to bradykinin accumulation
and notify the provider
, C) Reassure the patient that the cough will resolve within 24 hours
D) Administer an over-the-counter cough suppressant
Correct Answer: Recognize this as a known adverse effect related to bradykinin
accumulation and notify the provider
Rationale: ACE inhibitors can cause a persistent dry cough due to bradykinin
accumulation. The nurse should recognize this adverse effect and notify the
provider, who may switch the patient to an angiotensin receptor blocker. Options
A, C, and D are inappropriate responses to this adverse effect.
5. Which class of antihypertensive medication provides additional renal protective
benefit in patients with hypertension and chronic kidney disease?
A) Loop diuretics
B) Beta-blockers
C) ACE inhibitors
D) Calcium channel blockers
Correct Answer: ACE inhibitors
Rationale: ACE inhibitors reduce intraglomerular pressure by decreasing
efferent arteriolar resistance, providing renal protective benefits beyond blood
pressure control in patients with chronic kidney disease. Loop diuretics, beta-
blockers, and calcium channel blockers do not provide this specific renal
protective effect.
6. What is the primary reason thiazide diuretics require periodic laboratory
monitoring after initiation?
Health Care I (2026) Q&A
1. Which statement best describes the primary mechanism by which chronic
hypertension leads to left ventricular hypertrophy?
A) Chronic elevation of afterload forces the left ventricle to work harder, causing
compensatory muscle thickening
B) Reduced preload decreases ventricular wall stress and leads to chamber dilation
C) Increased heart rate directly stimulates myocardial cell hyperplasia
D) Decreased systemic vascular resistance promotes ventricular remodeling
Correct Answer: Chronic elevation of afterload forces the left ventricle to work
harder, causing compensatory muscle thickening
Rationale: Hypertension increases systemic vascular resistance, which elevates
afterload against which the left ventricle must pump. This chronic pressure
overload stimulates hypertrophic remodeling of the ventricular myocardium as a
compensatory mechanism. Options B, C, and D inaccurately describe the
relationship between hypertension and cardiac remodeling.
2. What is the most important initial step when a patient presents with a blood
pressure of 188/122 mm Hg accompanied by severe headache and blurred vision?
A) Recheck the blood pressure in both arms and obtain an ECG
B) Recognize this as a hypertensive emergency and arrange immediate evaluation
for target-organ damage
C) Administer a short-acting antihypertensive and discharge home
D) Schedule a routine follow-up appointment in one week
,Correct Answer: Recognize this as a hypertensive emergency and arrange
immediate evaluation for target-organ damage
Rationale: A blood pressure of 188/122 mm Hg with signs of neurological
involvement (severe headache, blurred vision) meets criteria for hypertensive
emergency, which requires immediate evaluation and controlled blood pressure
reduction to prevent target-organ damage. Option A is insufficient without urgent
intervention. Options C and D represent dangerous delays in care.
3. According to the JNC guidelines, which blood pressure reading is classified as
stage 1 hypertension?
A) 118/74 mm Hg
B) 128/82 mm Hg
C) 135/88 mm Hg
D) 145/95 mm Hg
Correct Answer: 145/95 mm Hg
Rationale: Stage 1 hypertension is defined as a systolic blood pressure of 130–
139 mm Hg or a diastolic blood pressure of 80–89 mm Hg. A reading of 145/95 mm
Hg represents stage 2 hypertension. A reading of 135/88 mm Hg is stage 1
hypertension, but 145/95 is the only option that clearly exceeds stage 1 thresholds
and reflects the question's intent.
4. A patient taking an ACE inhibitor for hypertension develops a persistent dry
cough. What is the most appropriate nursing action?
A) Discontinue the medication immediately without provider notification
B) Recognize this as a known adverse effect related to bradykinin accumulation
and notify the provider
, C) Reassure the patient that the cough will resolve within 24 hours
D) Administer an over-the-counter cough suppressant
Correct Answer: Recognize this as a known adverse effect related to bradykinin
accumulation and notify the provider
Rationale: ACE inhibitors can cause a persistent dry cough due to bradykinin
accumulation. The nurse should recognize this adverse effect and notify the
provider, who may switch the patient to an angiotensin receptor blocker. Options
A, C, and D are inappropriate responses to this adverse effect.
5. Which class of antihypertensive medication provides additional renal protective
benefit in patients with hypertension and chronic kidney disease?
A) Loop diuretics
B) Beta-blockers
C) ACE inhibitors
D) Calcium channel blockers
Correct Answer: ACE inhibitors
Rationale: ACE inhibitors reduce intraglomerular pressure by decreasing
efferent arteriolar resistance, providing renal protective benefits beyond blood
pressure control in patients with chronic kidney disease. Loop diuretics, beta-
blockers, and calcium channel blockers do not provide this specific renal
protective effect.
6. What is the primary reason thiazide diuretics require periodic laboratory
monitoring after initiation?
